Healthcare Provider Details

I. General information

NPI: 1588927628
Provider Name (Legal Business Name): MARK D COOK, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 W H ST STE 200
OAKDALE CA
95361-3588
US

IV. Provider business mailing address

1425 W H ST STE 200
OAKDALE CA
95361-3588
US

V. Phone/Fax

Practice location:
  • Phone: 209-848-1005
  • Fax: 209-845-8918
Mailing address:
  • Phone: 209-848-1005
  • Fax: 209-845-8918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA60965
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK DANIEL COOK
Title or Position: OWNER
Credential: M.D.
Phone: 209-848-1005